18Rotator Cuff TearAtrophy or thinning of the muscles about the shoulderPain when someone lift the armPain when someone lower the arm from a fully raised positionWeakness when someone lift or rotate the armCrackling sensation when someone move his shoulder in certain positions

20Rotator Cuff Tear Pain relief Improve the function of shoulder.It may take several weeks or months to restore the strength and mobility to ones shoulder.Rest and limited overhead activityAnti-inflammatory medicationSteroid injectionStrengthening exercise and physical therapy

28Viscosupplementation (HA)Hyaluronic AcidVariable injection scheduleTheoretical benefit is to improve lubrication in the jointFDA approved for the knee, and has some scientific supportWang et al: JBJS 2004Metaanalysis, confirmed efficacy and safety of treatmentMinimal literature on usage in the shoulderShibata et al (JSES 2001) found it to be equal to corticosteroids in those with rotator cuff tearsSilverstein et al AJSM 2007

2930 patients w/ idiopathic glenohumeral OAStatistically significant improvements in VAS, UCLA score, and Simple Shoulder Test Score at 6 months~50% had less than 2 point improvement in VASNo complicationsConclusion: HA may have a beneficial effect on some patients with glenohumeral OAReasonable option in patients that are not surgical candidates